Effects of Altitude Training on Running Performance

A Review for Elite Athletes and Coaches

Stephanie Eyler

Spring 2005

A paper for Sports Illustrated and ESPN magazine

For years, athletes, coaches and the general public have believed that training at

higher altitude will cause improved athletic performance upon return to sea level. This

training technique has been an essential practice of many athletic teams, especially elite

teams trying to gain the extra edge over the competition. Despite this widely believed

altitude training method, studies have been performed that found training at higher

altitudes does not achieve differing performance results than training at low. Several

studies have even shown that optimum performance results may be accomplished through

low altitude training. With such differing opinions on athletic altitude training it is vital

for the public, especially elite athletes and coaches, to explore all sides of the issue to

determine the ultimate training technique.

There are several factors measured throughout the studies involved in determining

if training at higher altitude improves running performance on return to sea level. In

order to understand the results and the magnitude of the findings, the reader needs to

understand altitude, acclimatization, maximal oxygen uptake (VO2max), hemoglobin

concentration, blood lactate, red cell mass volume, erythropoietin concentration (Epo),

and buffer capacity.

Altitude

1
At altitude, atmospheric pressure is lower than normal (760 mmHg at sea level).

Proportion of oxygen and nitrogen molecules remain the same under all altitudes,

however the partial pressure of each will decrease at increasing altitude. The partial

pressure is important because blood hemoglobin is best saturated with oxygen at higher

partial pressures. Therefore, since altitude creates lower partial pressure of oxygen,

hemoglobin is not fully saturated with oxygen.

Acclimatization

The physiological adaptations of the body to changes in altitude. The time taken for

these physiological changes can vary among different people; however, in general it takes

about ten days to acclimatize 80%, and six weeks to almost fully acclimatize (Ruble).

During acclimatization red blood cell production increases, as well as the number of

capillaries within the tissues. Blood viscosity (thickness) increases, creating higher

resistance to blood flow, thus causing the heart to work harder (Sherwood).

Acclimatization is believed to improve oxygen transport to muscles (Faulkner et al.,

Levine and Gundersen, Saunders et al.)

Maximal Oxygen Uptake VO2max

Maximum volume of oxygen a person uses per minute to create energy. Indicates

capacity of body to supply oxygen to tissues. The best predictor of a persons work

capacity (Sherwood).

Hemoglobin Concentration

Hemoglobin is the iron containing pigment of red blood cells, which is responsible for

obtaining and carrying oxygen molecules received from breathing. The hemoglobin

delivers the oxygen to tissues, where it is then used to create energy. Under altitude

2
conditions, hemoglobin is not fully saturated. In order raise available oxygen levels to

healthier amounts, the concentration of hemoglobin increases. Hemoglobin can also

carry carbon dioxide and H+ ions, both of which are acidic components; therefore, blood

acidity can affect oxygen content of hemoglobin.

Blood Lactate

Lactic acid accumulates in blood in response to exercise. Lactic acid dissociates to create

H+ ions, which increases the pH of the blood. As previously mentioned, blood acidity

can affect oxygen content of hemoglobin. Lactic acid also creates muscle soreness and

muscle fatigue.

Red Cell Mass Volume

Blood consists of plasma, red and white blood cells, and platelets. Production increases

30% at altitude, compared to sea level production (Reynafarje). Red blood cells contain

hemoglobin, which, as previously mentioned is responsible for retrieving and

transporting oxygen to tissues. Increased red cell mass volume indicates higher levels of

hemoglobin, thus more oxygen capacity.

Erythropoietin

Hormone released from kidneys to stimulate production of red blood cells from bone

marrow. Produced in response to decreased levels of oxygen in body tissue. Production

is three times higher at altitude than at sea level (Reynafarje).

Buffer Capacity

Hemoglobin buffer system absorbs H+ ions produced from working muscles. Without

buffers H+ ions will accumulate, increasing the pH of the blood. As previously

mentioned, increase of blood pH can affect oxygen content of hemoglobin.

3
 Now that measured factors have been explained, studies can be examined to

determine if training at altitude will improve running performance at sea level. Actual

measures of running performance upon return to sea level and changes in VO2max will

indicate the answer. Furthermore, the other measured variables will aid in the

explanation of mechanisms for the reached conclusion.

Several studies directly tested the changes in running performance on return

arrival to sea level after training regimens at higher altitudes and on completion of

training at lower altitude or sea level. The following figure (Figure 1) presents

conflicting results of several studies; some reveal that higher altitude training improves

running performance at sea level, several indicate that low altitude training obtains best

performance results upon return to sea level, and a couple suggest no difference between

the outcomes of moderate and low altitude training on performance at sea level. Since

studies do not test at the exact same altitude ranges have been designated to differentiate

between low, moderate and high altitudes: 3000 m and higher is considered high altitude,

2200-2999 m is moderate altitude, and 0-2199 is low altitude.

HIGHER ALTITUDE LOWER ALTITUDE NO DIFFERENCE IN

TRAINING IMPROVES TRAINING IMPROVES RUNNING
RUNNING RUNNING PERFORMANCE
PERFORMANCE PERFORMANCE AFTER ALTITUDE
TRAINING
Faulkner et After return Saunders et Training at low Adams et No
al. to sea-level, al. altitude (but al. enhancing
time trial also living at effect of
performances moderate hard
of all the altitude) endurance
subjects improved training at
improved running altitude on
compared to performance in performance
prealtitude distance time
control runners
values.

4
 HIGHER ALTITUDE LOWER ALTITUDE NO DIFFERENCE IN
TRAINING IMPROVES TRAINING IMPROVES RUNNING
RUNNING RUNNING PERFORMANCE
PERFORMANCE PERFORMANCE AFTER ALTITUDE
TRAINING
Burtscher Exercise Nummela 400 m Buskirk et Performance
et al. performance and Rusko performance al. times were
improved: improved after similar on
-from 1 week living in return from
before to 3 normobaric altitude
days after hypoxia training to
training at (simulated what they
altitude altitude) and were before
-from 3 days training at sea going to
after to 16 level altitude.
days after
training at
altitude
Chapman et Significant
al. improvement in
5000m running
performance
after living at
high altitude
and training at
low altitude
Stray- Acclimatization
Gundersen to moderate
et al. altitude while
training at high
intensity at low
altitude
improves sea
level endurance
performance
Levine and 5 km time trial
Stray- improved by
Gundersen moderate
altitude
acclimatization
and low
altitude training
Figure 1: Results supporting enhancement of running performance from high altitude and low altitude, and
finding no effect. Adams et al. study trained at moderate altitude, Burskirk et al. study trained at high
altitude.

5
HIGHER ALTITUDE TRAINING IMPROVES RUNNING PERFORMANCE

Two studies have demonstrated that after training at higher altitude more

improvement in running performance can be achieved at sea level. Faulkner et al. timed

the running performance at sea level of five well-conditioned men after they trained for

three weeks at moderate altitude. Time trials of one and two mile runs at sea level after

altitude training were significantly decreased from pre-altitude training times; times were

decreased on average by 29 seconds for the mile and one minute and 11 seconds for two

miles, while the controls decreased only an average of 18 seconds for the mile and 46

second average for the two mile. Keep in mind that though the control subjects

demonstrated an improvement in time, they did not train at altitude; thus their

improvement is due to actual training and practice. The results of this study, however, are

weakened by the fact that only five subjects were tested. This low subject number may

effect the actual results applying to the general population, and therefore cannot be

heavily relied upon to support that training at altitude will improve running performance

in elite athletes upon return to sea level.

Burtscher et al. obtained similar improvement in performance upon return to sea

level. A group of ten amateur males trained for 12 days at moderate altitude and had total

work capacity measured the week before altitude training, and three and 16 days after

altitude training. Total work capacity indicates the maximum amount of force produced

over a certain distance, and in this study was found to increase 16 percent by day 16 after

altitude. The control group, however, only increased a total of eight percent by day 16.

Since the subjects tested after altitude training enhanced TWC, that means more muscle

fibers were recruited for the activity, thus the activity was performed faster. Despite these

6
supportive results indicating training at altitude can improve running performance, two

flaws of the study decrease its validity. Most importantly is the fact that amateur subjects

were tested. These subjects entered the study at low levels of athletic ability, thus

training of any kind would enhance running performance; it cannot be assumed that

altitude is the causing factor. Also, the study does not directly measure times of running

performance. Though enhanced total work capacity occurred, specific time differences

cannot be determined from the percent change in TWC. Both these factors combine to

weaken the total validity of the study in regards to our purpose.

NO DIFFERENCE IN RUNNING PERFORMANCE AFTER ALTITUDE

TRAINING

Conclusions are not always met in all studies indicating which altitude training

creates optimal running performance upon return to sea level. These inconclusive studies

further contribute to this already unresolved issue. The Burskirk et al. study concluded no

improved post-high-altitude performance out of any of the six tested runners. Though

only six subjects were tested, the subjects were trained at altitude for over 60 days. Such

a large amount of time, gives each body plenty of time to acclimatize to the altitude,

therefore all physiological changes were able to occur. Considering the length of the

training, the study provides convincing results indicating that training at altitude has no

added effect on running performance. Another study found results in favor of sea level

training. The control group (training at sea level) improved running performance time by

7 seconds, while the group training at moderate altitude increased time by 7 seconds

(Adams et al.). Similar to the Burskirk et al. study, the Adams et al. study trained at

altitude for appropriate for complete acclimatization, and even increased the number of

7
subjects to 12. As opposed to earlier studies with only six and ten subjects, even slight

increase in subject number can increase the validity and applicability of results.

LOWER ALTITUDE TRAINING IMPROVES RUNNING PERFORMANCE

Several studies have found that training at a low altitude improves running

performance, many of which contained methods creating the most valid results. Levine

and Stray-Gundersen tested thirty nine distance runners in various conditions: living and

training at moderate altitude, living at moderate altitude and training at low altitude, and

living and training at low altitude. After training at altitude levels for four weeks it was

determined that the second group that lived at moderate, but trained at low altitude

achieved improvement in running performance by an average of 13.4 seconds, while the

other groups found an increase in time trials by up to an average 26.7 seconds in the low

altitude (control) group. Similar study techniques were applied in the Saunders et al.

study, which tested 22 elite male middle and long distance runners. This study observed

personal best running times a month after training in all the subjects the lived at moderate

altitude and trained at low altitude, but only three of the 13 subjects achieved personal

best out of the living and training low altitude group. Both of these studies were

performed on numbers of subjects well exceeding any study in support of altitude

training enhancing running performance. With 39 and 22 subjects tested, also over long

periods of time for full acclimatization, results can be accurately applied to the elite

athlete population.

An additional study on well-trained distance runners discovered similar results. A

reduction of an average of 5.8 seconds in running performance after altitude training was

8
seen in the group living at moderate altitude and training at low altitude, while the

opposing control group (living and training at low altitude) had widely variable results

among the subjects, including as much as an 18 second increase in time (Stray-Gundersen

et al.). This study contains valuable findings indicating low altitude training generate

optimal running performance, however keep in mind that a group was not tested for

training at altitude. This makes it difficult to apply to this reviews purpose; however, it

gives light to a different approach to optimal training technique.

Nummela and Rusko also looked into training athletes at low altitude after living

at moderate altitude. The 18 well-trained sprinters were split into a group of eight living

moderate altitude (in an altitude house) and training low, and ten as a control group at sea

level. At the conclusion of the ten day testing, results illustrated all runners that lived at

moderate altitude but trained at low altitude improved running times after return to sea

level by an average of 0.42 seconds. No changes were seen in the control group. Keep in

mind that, though, 0.42 seconds may seem a very minimal improvement, for competitive

athletes, even the slightest improvement can place them over their opponents. This study

introduces an approach different from previously explained studies; the use of an altitude

house. This altitude house created an environment known as normobaric hypoxia, or a

house of normal pressure but with less oxygen. Results are slightly weakened due to the

fact that pressure remains the same as normal sea level conditions; however, the fact that

less oxygen was available still holds importance. It is the lack of oxygen molecules that

create most physiological changes during acclimatization; therefore, results may still be

lightly applied to this reviews issue.

9
 Figure 2 graphically presents the changes in running performance times from

several of the above explained studies. Obviously, the issue is not completely resolved

since both low and moderate altitude training has shown to decrease performance times.

However, moderate altitude training also was found to increase time. With the

weaknesses and strengths explained for the previous studies, it seems most logical to

conclude that training at altitude does not create optimal running performance.

Figure 2: Effects of Altitude Training on Running Performance at Sea Level. Low Altitude=0-2199 m,
Moderate Altitude=2200-2999 m. All studies graphed show results from well-conditioned or elite athletes.
Negative values represent improved running performance time; positive values are added time to pre-
altitude running times.

Aside from time trial measurements, VO2max is another major measured variable

which indirectly indicate changes in running performance. VO2max increases cause the

increase of oxygen molecules in tissues to create a higher rate of energy production

through oxidative pathways. If the body creates more energy, then it is obvious that

10
athletic performance will be enhanced. The issue now converts to if altitude training will

increase VO2max, which indirectly can help to answer our original question whether

altitude training improves running performance. After reviewing several studies, this

issue still proves to be unresolved. Several studies have shown that low, moderate and

high altitude training can increase VO2max, while one other study has shown a decrease

from moderate. The following figure (Figure 3) illustrates results from these conflicting

studies.

Figure 3: Change in Maximal Oxygen Uptake (VO2max) from Altitude Training. Low altitude=0-2199 m,
Moderate altitude=2200-2999 m, High altitude=3000+m. There are no visible bars for Adams et al. study
because the study found no changes in VO2max in either low or moderate altitude training.

Most of the studies, except one, presented in figure 3 indicate that altitude training

will improve VO2max. The Saunders et al. study discovered that altitude training did not

increase VO2max, which indicate that altitude training will not indirectly improve running

performance. VO2max after training at moderate altitude decreased 3.3 percent from pre-

11
altitude levels in ten elite male middle and distance runners. No changes in VO2max were

found in Adams et al.s study.

The remaining six studies demonstrated ranges from three percent to nine percent

increases in VO2max. Though there is one conflicting and one inconclusive study, one may

deduce that in most cases VO2max will increase after altitude training. The figure also

indicates that perhaps moderate altitude creates optimal results compared to low and high

altitude training. Even though this conclusion can be reached from the graph, keep in

mind that VO2max is only an indicator of running performance; it is only one key factor in

running performance (Fallowfield). This is obvious since this article previously found

that running performance improved more at low altitude training.

There are several studies indicating higher altitude training will improve running

performance upon return to sea level, the Faulkner et al. study, the Burtscher et al. study,

and even perhaps the six studies illustrating increased VO2max in figure 3. However, these

studies have been previously scrutinized for limited number of tested subjects, training

time, and slightly overreaching assumptions. Such limitations of the studies and results

indicate a weaker argument supporting major beneficial results to altitude training.

Numerous findings do oppose the general publics assumption that higher altitude

training improves running performance upon return to sea level. As mentioned in figure

1, five studies found that low altitude training enhanced running performance at sea level.

Many of these studies tested several subjects, as opposed to the Faulkner et al. and

Burtscher et al. studies, which only tested five and ten people, respectively. Therefore,

the studies convincingly indicate that higher altitude does not necessarily improve

running performance at sea level.

12
 Furthermore, it has been introduced that perhaps living at high altitude but

training at low altitude will create optimal performance at sea level. How can this occur?

As previously mentioned, acclimatization is believed to improve oxygen transport to

muscles. This improved transport occurs due to increased VO2max, erythropoietin

production, red cell mass, hemoglobin concentration, buffer capacity and decreased blood

lactate. Since these physiological changes facilitate the transport of oxygen to the

muscles, more energy is created in the muscle. So if acclimatization can create these

positive effects for athletes, how does altitude training affect the ultimate improvement in

running performance? High altitude training is known to decrease athletic capacity

because maximal aerobic power decreases about 1% for every 100 meters above 1,500 m

(Levine and Stray-Gundersen). If elite athletes are training at a lower capacity than

normally possible, their training will not necessarily improve or even maintain the

athletes competitive fitness. As mentioned previously, every split second is of utmost

importance in the world of elite sports. If these athletes choose to train at a level below

maximum capability they will not maintain or improve performance compared to those

placing 100% into training at lower altitudes.

In a society that places sports in the spotlight, athletes and coaches are constantly

trying to find the ways to create the winning team. This review has illustrates that despite

popular belief, higher altitude training does not create optimum running performance at

sea level; perhaps the answer is in low altitude training. However, acclimatization has

also become focus for optimal training methods. Elite athletes and coaches should

seriously consider researching more about the live high train low theory in order to gain

an extra edge over the competition.

13
REFERENCES:

Adams, William C., Edmund M. Bernauer, D. B. Dill and John B. Bomar, Jr. (1975).
Effects of equivalent sea-level and altitude training on VO 2max and running
performance. Journal of Applied Physiology, 39(2), 262-266.
Burtscher, M., W. Nachbauer, P. Baumgartl, and M. Philadelphy. (1996). Benefits of
training at moderate altitude versus sea level training in amateur runners.
European Journal of Applied Physiology, 74, 558-563.
Buskirk, E. R., J. Kollias, R. F. Akers, E. K. Prokop, and E. P. Reategui. (1967). Maximal
performance at altitude and on return from altitude in conditioned runners.
Journal of Applied Physiology, 23(2), 259-266.
Chapman, Robert F., James Stray-Gundersen, and Benjamin D. Levine. (1998).
Individual variation in response to altitude training. Journal of Applied
Physiology, 85(4), 1448-1456.
Clark, Sally A., Robert J. Aughey, Christopher J. Gore, Allan G. Hahn, Nathan E.
Townsend, Tahnee A. Kinsman, Chin-Moi Chow, Michael J. McKenna and John
A. Hawley. (2003). Effects of live high, train low hypoxia exposure on lactate
metabolism in trained humans. Journal of Applied Physiology, 96, 517-525.
Dill, DB., and William Adams. (1971). Maximal oxygen uptake at sea level and at 3,090-
m altitude in high school champion runners. Journal of Applied Physiology, 30(6),
845-859.
Fallowfield, Joanne and David Wilkinson. (1999). Improving Sports Performance in
Middle and Long Distance Running. England: John Wiley and Sons, Ltd.
Faulkner, John A., Jack T. Daniels, and Bruno Balke. (1966). Effects of training at
moderate altitude on physical performance capacity. Journal of Applied
Physiology, 23(1), 85-89.
Favier, R., H. Spielvogel, D. Desplanches, G. Ferretti, B. Kayser, A. Grunenfelder, M.
Leuenberger, L. Tuscher, E. Caceres and H. Hoppeler. (1995). Training in hypoxia
vs. training in normoxia in high-altitude natives. Journal of Applied Physiology,
78(6), 2286-2293.
Levine, Benjamin D., and James Stray-Gundersen. (1997). Living high-training low:
effect of moderate-altitude acclimatization with low-altitude training on
performance. Journal of Applied Physiology, 83(1), 102-112.
Nummela, Ari, and Heikki Rusko. (2000). Acclimatization to altitude and normoxic
training improve 400-m running performance at sea level. Journal of Sports
Sciences, 18, 411-419.
Reynafarje, Cesar. (1964). Hematologic Changes During Rest and Physical Activity in
Man at High Altitude. In WH Weihe, The Physiological Effects of High Altitude
(pp. 73-82). New York: MacMillan Company.
Ruble, Stephen and Technology Services. (Fall 1998).Lecture: Into the Heavens.
Physiology of Exercise, Exercise Science and Sports Medicine, Samford
University.
http://www.samford.edu/schools/education/essm/PHED473/altitudeandilln
ess/index.htm
Saunders, P. U., R. D. Telford, D. B. Pyne, R. B. Cunningham, C. J. Gore, A. G. Hahn,
and J. A. Hawley. (2004). Improved running economy in elite runners after 20

14
 days of simulated moderate-altitude exposure. Journal of Applied Physiology, 96,
931-937.
Sherwood, Lauralee. (2004). Human Physiology From Cells to Systems (5th ed.).
California: Thomson Learning, Inc.
Stray-Gundersen, James, Robert F. Chapman, and Benjamin D. Levine. (2001). Living
high-training low altitude training improves sea level performance in male and
female elite runners. Journal of Applied Physiology, 91, 1113-1120.

15